| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,479 |
1,650 |
$366K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,533 |
388 |
$127K |
| D0140 |
Limited oral evaluation - problem focused |
4,416 |
4,135 |
$124K |
| D1120 |
Prophylaxis - child |
2,757 |
2,716 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,222 |
3,162 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,163 |
2,101 |
$72K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
978 |
669 |
$70K |
| D9420 |
|
528 |
511 |
$63K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
191 |
148 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
838 |
586 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,586 |
1,390 |
$41K |
| D1110 |
Prophylaxis - adult |
1,035 |
1,001 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,390 |
3,171 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,964 |
2,910 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,676 |
1,637 |
$26K |
| D0330 |
Panoramic radiographic image |
1,060 |
1,010 |
$25K |
| D1351 |
Sealant - per tooth |
1,408 |
443 |
$23K |
| D0240 |
|
1,440 |
805 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
367 |
343 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,664 |
1,105 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
142 |
69 |
$10K |
| D8670 |
Periodic orthodontic treatment visit |
54 |
54 |
$10K |
| D0270 |
|
934 |
891 |
$9K |
| D0274 |
Bitewings - four radiographic images |
379 |
369 |
$8K |
| D4910 |
|
210 |
200 |
$8K |
| D2331 |
|
101 |
68 |
$6K |
| D2330 |
|
79 |
43 |
$5K |
| D8660 |
|
16 |
13 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
31 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$1K |
| D1354 |
|
131 |
40 |
$1K |